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METHODS
We used weighted Cox proportional hazards analysis to assess the independent association between CT findings and hospitalisation or death due to COPD exacerbation .
RESULTS
During a median follow-up of 4.4 years ( maximum 5.2 years ) , 338 COPD events were identified .
RESULTS
The risk of experiencing a future acute exacerbation of COPD resulting in hospitalisation or death was significantly increased in subjects with severe emphysema ( score 7 ) and severe airway thickening ( score 3 ) .
RESULTS
The respective HRs were 4.6 ( 95 % CI 3.0 to 7.1 ) and 5.9 ( 95 % CI 3.4 to 10.5 ) .
RESULTS
Severe bronchiectasis ( score 3 ) was not significantly associated with increased risk of adverse events ( HR 1.5 ; 95 % CI 0.9 to 2.5 ) .
CONCLUSIONS
Morphological correlates of COPD such as emphysema and airway thickening detected on CT scans obtained for other non-pulmonary indications are strong independent predictors of subsequent development of acute exacerbations of COPD resulting in hospitalisation or death .
###24851690
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OBJECTIVE
To explore the feasibility of making a preoperative diagnosis of lung adenocarcinoma shown as ground-glass nodule ( GGN ) on computed tomography ( CT ) .
METHODS
A total of 143 GGN lesions proved pathologically were divided randomly into A and B groups .
METHODS
Then each group was further divided pathologically into preinvasive lesion , minimal invasive adenocarcinoma ( MIA ) and invasive adenocarcinoma ( IAC ) subgroups .
METHODS
Group A ( n = 101 ) , size of lesion , proportion of ground glass opacity ( GGO ) composition of lesion , long diameter , longest diameter and size of solid component in lesion were measured on CT so as to establish the CT diagnostic standard of lung adenocarcinoma shown as GGN on CT. .
METHODS
Group B ( n = 42 ) was employed to evaluate the accuracy of the above CT diagnostic standard .
METHODS
SPSS 17.0 software was used for statistical analysis .
RESULTS
Significant statistic significance existed in all parameters among all groups ( P < 0.05 ) .
RESULTS
All parameters were correlated the pathologic type of lesion .
RESULTS
The differences were statistically significant ( P = 0.000 ) .
RESULTS
Through the receiver operating characteristic ( ROC ) curve , between groups of preinvasive lesion and MIA , each parameter had a medium diagnostic value of 0.70-0 .90 ; between groups of MIA and IAC , size of lesion and long diameter of solid component in lesion had a medium diagnostic value of 0.70-0 .90 , longest diameter of solid component , size of solid component in lesion and proportion of GGO composition of lesion had a high diagnostic value with an AUC of > 0.90 .
RESULTS
The CT diagnostic standard , derived from group A , was used to analyze the pathologic type of group B. And t no significant statistic significance existed between CT preoperative diagnosis and operative pathologic diagnosis ( P > 0.05 ) .
RESULTS
The correct diagnosis rates of size of lesion , proportion of GGO composition of lesion , long diameter , longest diameter and size of solid component in lesion were 71.43 % , 76.19 % , 90.05 % , 90.05 % and 88.10 % respectively .
CONCLUSIONS
Based upon size of lesion , proportion of GGO composition of lesion , long diameter , longest diameter and size of solid component in lesion , preoperative CT examination may be used to determine the pathological types of lung adenocarcinoma shown as GGN .
###25883103
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OBJECTIVE
Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids .
OBJECTIVE
Pain control is still a big problem after tonsillectomy surgery .
OBJECTIVE
We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management .
OBJECTIVE
This is the first-time use of montelukast in post-tonsillectomy pain .
METHODS
Double-blind , controlled-randomized study .
METHODS
University teaching and research hospital .
METHODS
A total of 60 children , aged 5 to 15 years , American Society of Anesthesiologist class I-II , scheduled for elective tonsillectomy were enrolled in this clinical trial study .
METHODS
The patients were randomized into 2 groups : the montelukast group ( group M , n = 30 ) and control group ( group C , n = 30 ) .
METHODS
Group M recieved an oral montelukast tablet and group C recieved placebo at 2400pm on the morning before surgery .
METHODS
Post-tonsillectomy pain was evaluated with the Wong-Baker FACES Scale during the 24 hours after surgery .
METHODS
Patients ' intraoperative hemodynamic parameters and intraoperative and postoperative complications were recorded .
RESULTS
There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores ( P < .05 ) .
RESULTS
In the 24 hours after surgery , the total number of patients using rescue analgesics was higher in group C than in group M , and the difference was statistically significant ( P < .001 ) .
RESULTS
There was no significant difference in demographic parameters ( P > .05 ) .
RESULTS
There were no significant differences in postoperative nausea and vomiting , otalgia , trismus , fever , or halitosis between the groups ( P > .05 ) .
CONCLUSIONS
Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children .
###24318863
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OBJECTIVE
Metastatic colon cancer patients are treated with the chemotherapy regimens , FOLFOX and FOLFIRI , in either order .
OBJECTIVE
So far , we can not predict the response of chemotherapeutic agent , so it is necessary to find which regimen is adequate before starting chemotherapy .
METHODS
Enrolled patients are randomized into either conventional treatment or planned treatment preceded by pretreatment genetic analysis .
METHODS
Blood samples of patients in planned treatment group ( N = 53 ) were analyzed for the genetic polymorphism before selection of chemotherapeutic agents .
METHODS
Target genes were XPD-751 , GSTP-1-105 , XRCC1-399 for oxaliplatin , UGT1A1 for irinotecan .
METHODS
The response was measured by computed tomographic scan after completion of three cycles of chemotherapy .
RESULTS
Overall response rate was significantly higher in planned group ( 67.9 % vs. 46.3 % , P = 0.020 ) .
RESULTS
In FOLFOX group , response rate was significantly improved in the planned patients ( 77.1 % vs. 50 % , P = 0.018 ) .
RESULTS
In FOLFIRI group , the difference did n't reach statistical significance ( 50 % vs. 42.5 % , P = 0.776 ) .
CONCLUSIONS
We found significantly improved response rates in the chemotherapy of metastatic colon cancer by pretreatment genetic analysis , especially in FOLFOX group .
###25872502
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BACKGROUND
Cardiac arrest causes ischaemic brain injury .
BACKGROUND
Arterial carbon dioxide tension ( PaCO2 ) is a major determinant of cerebral blood flow .
BACKGROUND
Thus , mild hypercapnia in the 24 h following cardiac arrest may increase cerebral blood flow and attenuate such injury .
BACKGROUND
We describe the Carbon Control and Cardiac Arrest ( CCC ) trial .
METHODS
The CCC trial is a pilot multicentre feasibility , safety and biological efficacy randomized controlled trial recruiting adult cardiac arrest patients admitted to the intensive care unit after return of spontaneous circulation .
METHODS
At admission , using concealed allocation , participants are randomized to 24 h of either normocapnia ( PaCO2 35 to 45 mmHg ) or mild hypercapnia ( PaCO2 50 to 55 mmHg ) .
METHODS
Key feasibility outcomes are recruitment rate and protocol compliance rate .
METHODS
The primary biological efficacy and biological safety measures are the between-groups difference in serum neuron-specific enolase and S100b protein levels at 24 h , 48 h and 72 h. Secondary outcome measure include adverse events , in-hospital mortality , and neurological assessment at 6 months .
CONCLUSIONS
The trial commenced in December 2012 and , when completed , will provide clinical evidence as to whether targeting mild hypercapnia for 24 h following intensive care unit admission for cardiac arrest patients is feasible and safe and whether it results in decreased concentrations of neurological injury biomarkers compared with normocapnia .
CONCLUSIONS
Trial results will also be used to determine whether a phase IIb study powered for survival at 90 days is feasible and justified .
BACKGROUND
Australian New Zealand Clinical Trials Registry ACTRN12612000690853 .
###24226487
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BACKGROUND
For decades thiopental has been considered as the hypnotic drug of choice for intracranial surgery .
BACKGROUND
However , total intravenous anesthesia performed with thiopental is associated with delayed recovery , whereas early post-operative neurological evaluation is critical .
BACKGROUND
For this reason , target controlled infusion ( TCI ) of propofol is increasingly used for maintenance of anesthesia .
BACKGROUND
However , a thiopental TCI has never been assessed for this purpose .
BACKGROUND
We tested the hypothesis that a thiopental TCI provides an acceptable way to achieve early recovery compared to a propofol TCI during supratentorial surgery .
METHODS
Eighty patients undergoing elective craniotomy for a supratentorial tumor were randomized to receive either a propofol TCI ( group P ) or a thiopental TCI ( group T ) .
METHODS
Both groups received a sufentanil TCI and the bispectral index was monitored .
METHODS
The primary end-point was time to tracheal extubation .
METHODS
Secondary end-points were per - and post-operative hemodynamics as well as respiratory and recovery parameters .
METHODS
Assessment of study end-points was performed by an intensive care specialist blinded ( like the patient ) to the received hypnotic .
RESULTS
Time to extubation was significantly ( P < 0.0001 ) shorter in group P ( median 149 minutes ; interquartile range 72-250 minutes ) than in group T ( median 453 minutes ; interquartile range 286-813 minutes ) .
RESULTS
Similarly , the recovery parameters were significantly better in group P than in group T.
RESULTS
There was no difference between groups in terms of patient characteristics and hemodynamic parameters .
CONCLUSIONS
Even with TCI and bispectral index monitoring , thiopental is associated with an inappropriate delayed recovery from supratentorial surgery compared to propofol TCI .
###25539560
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OBJECTIVE
To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome .
METHODS
Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study .
METHODS
We divided these patients into 2 groups , whereby 32 ( 47 % ) patients received conservative therapy before arthroscopic subacromial decompression and 36 ( 53 % ) patients did not receive conservative therapy .
METHODS
We compared both groups in terms of the the Constant , UCLA , and VAS scores for shoulder pain before and after arthroscopic subacromial decompression .
RESULTS
Constant , UCLA , and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression ( P < 0.001 ) .
RESULTS
Constant , UCLA , and VAS scores before arthroscopic subacromial decompression were statistically better in Group 1 than in Group 2 ( P < 0.001 ) .
RESULTS
No statistically significant difference was found between the groups in terms of Constant , UCLA , and VAS scores after arthroscopic subacromial decompression ( P > 0.05 ) .
CONCLUSIONS
Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression .
###24401051
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BACKGROUND
Obstructive sleep apnea is associated with considerable health risks .
BACKGROUND
Although continuous positive airway pressure ( CPAP ) can mitigate these risks , effectiveness can be reduced by inadequate adherence to treatment .
BACKGROUND
We evaluated the clinical safety and effectiveness of upper-airway stimulation at 12 months for the treatment of moderate-to-severe obstructive sleep apnea .
METHODS
Using a multicenter , prospective , single-group , cohort design , we surgically implanted an upper-airway stimulation device in patients with obstructive sleep apnea who had difficulty either accepting or adhering to CPAP therapy .
METHODS
The primary outcome measures were the apnea-hypopnea index ( AHI ; the number of apnea or hypopnea events per hour , with a score of 15 indicating moderate-to-severe apnea ) and the oxygen desaturation index ( ODI ; the number of times per hour of sleep that the blood oxygen level drops by 4 percentage points from baseline ) .
METHODS
Secondary outcome measures were the Epworth Sleepiness Scale , the Functional Outcomes of Sleep Questionnaire ( FOSQ ) , and the percentage of sleep time with the oxygen saturation less than 90 % .
METHODS
Consecutive participants with a response were included in a randomized , controlled therapy-withdrawal trial .
RESULTS
The study included 126 participants ; 83 % were men .
RESULTS
The mean age was 54.5 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 28.4 .
RESULTS
The median AHI score at 12 months decreased 68 % , from 29.3 events per hour to 9.0 events per hour ( P < 0.001 ) ; the ODI score decreased 70 % , from 25.4 events per hour to 7.4 events per hour ( P < 0.001 ) .
RESULTS
Secondary outcome measures showed a reduction in the effects of sleep apnea and improved quality of life .
RESULTS
In the randomized phase , the mean AHI score did not differ significantly from the 12-month score in the nonrandomized phase among the 23 participants in the therapy-maintenance group ( 8.9 and 7.2 events per hour , respectively ) ; the AHI score was significantly higher ( indicating more severe apnea ) among the 23 participants in the therapy-withdrawal group ( 25.8 vs. 7.6 events per hour , P < 0.001 ) .
RESULTS
The ODI results followed a similar pattern .
RESULTS
The rate of procedure-related serious adverse events was less than 2 % .
CONCLUSIONS
In this uncontrolled cohort study , upper-airway stimulation led to significant improvements in objective and subjective measurements of the severity of obstructive sleep apnea .